Wednesday, November 28, 2012

Charlie Savage at the New York Times reports that "several people briefed on a Naval Criminal Investigative Service inquiry" into the death of Guantanamo detainee Adnan Farhan Abdul Latif, who was found unresponsive in his cell last September, have revealed that the prisoner "died from an overdose of psychiatric medication."

As Savage notes, the military autopsy has reportedly declared Latif died a suicide. Accordingly, investigators are said to be following up a scenario wherein the Yemeni detainee, recently moved from the psychiatric ward to a disciplinary solitary unit at Camp 5, hoarded medications somehow, and used them to overdose last September 8.

To date, we do not know what kinds of medications were involved, except they were "psychiatric" in nature. Nor do we know how many different medications were supposedly involved. While the Times article implies investigators are looking at pills, as explained below, Latif also received forceable injections of drugs at various times.

Jason Leopold broke the story labeling Latif's death a suicide in a November 26 article at Truthout. The autopsy report itself has not been publicly released, and has been the subject of wrangling between U.S. and Yemen authorities, a dispute that has left the former Guantanamo's body in limbo (allegedly frozen) at Ramstein Air Base in Germany.

Cause of Death vs. Manner of Death

While the government is pushing a suicide scenario, the facts of the case are, as Savage describes them, "murky." The NYT reporter cites alternate scenarios for a drug overdose put forward by one of Latif's civilian attorneys.

David Remes, a lawyer who represented Mr. Latif in a habeas corpus lawsuit, said there was reason to be suspicious about how his client was overmedicated, voicing skepticism that he could have hoarded his daily dosages without detection. He noted that Mr. Latif was under “intense scrutiny” — including regular monitoring by guards and cameras....

Mr. Remes, who has not seen the autopsy report, suggested that Mr. Latif instead may have negligently been given too many pills that day, which the lawyer doubted, or that the authorities might have deliberately given him access to too much medication hoping he would kill himself.

Intentional suicidal overdose, accidental overdose, and facilitated suicide aka murder are not the only possibilities. But before proceeding with that discussion, one should be clear that the revelation that Latif died of a drug overdose only refers to the cause of death, which moreover would have had to have been drug-related cardiac or respiratory arrest. But the manner of death speaks to what agency or circumstances brought about the cause of death, in this case, the drug overdose.

Broadly speaking, the manner of death had to have been either accidental, or intentional -- with intent attributed to the victim (suicide) or to the intent of others (murder). There are nuances between these. For instance, an accident in a medical setting could have been due to negligence or even malpractice. The idea of facilitated suicide -- a scenario I previously floated in relation to the death of another Guantanamo purported suicide, that of Mohammed Salih Al Hanashi -- combines malicious intent by others with suicidal intent by a prisoner.

Of course, one possibility is that Latif was murdered outright, e.g. that someone came into his cell and forced him to take drugs, or that drugs were placed in his food, or forcibly injected. One problem with the long period that elasped with Latif's body probably not adequately preserved is that now for evidence of any struggle we will have to rely singly upon the military's autopsy report.

The idea of the military covertly administering drugs is not that outrageous. Recently, it was revealed that DoD had put drugs into the food of David Hicks, an Australian detainee released in 2007, before he was brought before a hearing at the U.S.-run Cuban prison camp.

Another possible mode of death might have been via what has come to be called accidental death via "polypharmacy." As critics of psychiatric practice have noted, drugs are often prescribed in too great a number, with some drugs prescribed to deal with side effects of other drugs, until the total number of drugs prescribed becomes dangerous, and the interaction between drugs prescribed unpredictable.

The Department of Defense has been criticized for just this kind of practice, as described in this February 2011 Psychology Todayarticle by Dr. Allen Frances, "psychiatry professor emeritus and former chairman of psychiatry, Duke University who chaired the DSM-IV Task Force revision."

"Individual psychotropic drugs can have serious side effects -- in excessive combination they sometimes threaten respiratory and cardiac function in a potentially lethal way," Frances wrote. "And the whole is even more dangerous than the sum of its parts since the medications can interact to increase each other's blood levels. Prescription drugs are overtaking illegal drugs as the primary cause of accidental overdose and death."

Were Injections of "Chemical Restraints" Involved in Latif's "Overdose"?

In an October 18 story by Jason Leopold on the abuse Latif suffered at Guantanamo, Leopold reported on numerous instances of forcibly drugging of Latif by camp medical authorities. This drugging apparently included forced injections of "sedatives." The exact nature of the drugs are unknown, but an Inspector General report on use of "mind-altering" drugs on detainees "for purposes of interrogation," released via my FOIA request and analyzed by both Leopold and myself, noted that detainees at times were administered "chemical restraints."

I have made multiple requests to DoD officials to ask what drugs were used as chemical restraints. To date, no one from DoD has replied to my queries.

One of the few drugs mentioned in the IG report was Haldol, which was administered as an injection to Guantanamo detainee Adel al-Nusairi (referred to as IG-02 in the report). According to the IG, haldol is a powerful antipsychotic medication, whose side effects include lethargy, tremors, anxiety, mood changes and "an inability to remain motionless," among other disturbing effects.

The government has used haldol injections in other detention settings as well, most notoriously by the Immigration and Customs Enforcement agency for purposes of deportation of immigrants. A May 13, 2008 article in the Washington Post described the dangers of using the drug:

In September, the Food and Drug Administration issued an alert citing "a number of case reports of sudden death" and other reports of dangerous changes in heart rhythm. It is, important, the FDA warned, to inject Haldol only into muscles, not veins, and to avoid doses that are too high.

Federal officials finally greatly reduced use of haldol for sedation of deportees in 2009, after much public criticism and threat of lawsuits. But it is unknown to what degree the drug or others like it are currently used at Guantanamo or other DoD detention settings.

Did Latif receive haldol injections, or any other kind of drug injection (as, for instance, risperidone) in the week or two prior to his death? We shouldn't have to wait years to get an answer to this question. Indeed, this case in particular cries out for a full, independent, public investigation.

Death Threats

The absurdity of conducting a military investigation in this instance is manifest when one considers that in the weeks prior to Latif's death he was threatened with death by one or more Guantanamo guards.

The full story about this was reported by Jason Leopold in his November 26 article, but essentially, as reconstructed via detainee accounts given to David Remes, Latif complained about not getting needed medications sometime in early August. In frustration he reportedly threw a rock at a guard tower, and thereby brought the wrath of the armed guard force down upon him and other detainees.

As Leopold reported it:

"The guards came into Camp 5 with guns, and beat up the detainees," another prisoner recalled. "Other soldiers surrounded the camp. [The Officer in Charge] came and told detainees, 'You are extremists and I'm going to deal with you in a harsh way. You intend to kill our soldiers; we'll do the same thing to you.'"

For whatever reason, Savage did not report this aspect of the story in his article about the drug overdose. One wonders if the New York Times reporter hasn't already decided the case is simply one of suicide, a scenario investigators are reportedly pursuing. Just the other day, the Times editorial board called Latif's death a "suicide."

Savage did not note that investigators were pursuing any other leads. No one is talking, either, about what the surveillance tapes of Latif would show, or whether the evidence in them rules out one theory regarding manner of death or another.

Too Many Suspicious Deaths

The death of Latif, the first purported "suicide" who supposedly did not hang or strangle himself, is nevertheless similar to the other suicides, and none more than that of Mohammed Al Hanashi. Both had made multiple suicide attempts and been at various times on "suicide watch." Both were said to be depressed at the time of their death, although their are contrary reports regarding both that they were not suicidal at the time of their death. Both were under video surveillance. Both were supposed trouble-makers, and both had been hunger strikers.

Then there is the 2007 "suicide" of Abdul Rahman Al Amri, also found in a solitary cell in Camp 5, with his hands tied behind his back. The three "suicides" of May 2006 were also found with hands tied and rags stuffed down their throats. At least one guard witnessed stranger transfers of three prisoners to a possible black site at the Guantanamo base, known as Camp No, as reported in an award-winning 2010 article by Scott Horton at Harpers, and examined further in a special investigation by Seton Hall School of Law.

The latest revelations seriously demand the calling of a special investigation. The Department of Defense, embroiled in numerous scandals over torture, extrajudicial killings, rendition, and corruption, cannot be trusted to run an investigation into these deaths. The Naval Criminal Investigative Service, who is in charge of the investigation, along with another investigation run out of Guantanamo's parent command at SOUTHCOM, has been involved over the years in interrogations of detainees and in intelligence operations. To leave the investigation to NCIS and SOUTHCOM is to leave the institutions involved to investigate themselves.

There have been many calls to shut down Guantanamo of late. A Government Accounting Office study released just today, and touted by Democratic Senator and Chair of the Senate Select Committee on Intelligence, Diane Feinstein, has indicated the closure of Guantanamo and transfer of prisoners to U.S. prisons is perfectly feasible. But would justice still come to those many, many prisoners already cleared for release? Or would the closure of Guantanamo spawn many more Guantanamos, or via use of indefinite detention, "Gitmo-ize" the U.S. prison system?

Maybe a real investigation into the death of Latif would help bring about a greater understanding of why Guantanamo is an abomination that must be shut down. If true, then Latif would not have died in vain, an anonymous innocent man ground down and snuffed out by a system so large and inhuman that it seemed no one could control it.

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About Me

I am a psychologist, living in Northern California. Over the years I have written about torture, national security, civil rights and other topics. Most of my stories, including major investigatory pieces, some co-written with Jason Leopold, have been published at Firedoglake, Truthout, and The Public Record.
A full backlog of my pre-Invictus writing, going back to May 2005, can be found at my Daily Kos page.
E-mail me at sfpsych at gmail dot com.

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This documentary, by award-winning producer Sherry Jones, details how the secret U.S. military interrogation program - "Survival, Evasion, Resistance and Escape" - or SERE - became the basis for many of the harshest methods used in interrogating prisoners in U.S custody.